Subash Chandra Subudhi, Vikram Kumar Behera, Sudhansu Sekhar Patra, Antaryami Pradhan, Avilash Gourav Sahoo
Background: Empyema thoracis is a serious pleural infection in children, most often arising as a complication of bacterial pneumonia. It contributes significantly to morbidity and, if inadequately treated, may result in irreversible pulmonary damage. Video-assisted thoracoscopic surgery (VATS) has become a preferred minimally invasive approach for advanced empyema. Aims and Objectives: The aim of the study is to assess the safety and effectiveness of the two-port VATS technique in pediatric empyema thoracis, focusing on operative outcomes, complications, and recovery. Materials and Methods: A retrospective observational study was conducted over 2 years, including 50 pediatric patients aged 1 month to 15 years with stage II/III empyema that was unresponsive to medical therapy. All underwent two-port VATS for decortication and lung re-expansion. Data on operative time, hospital stay, complications, and conversion to thoracotomy were analyzed. Results: Two-port VATS achieved satisfactory lung re-expansion and effective decortication in the majority of cases. The mean operative time was 75 min, and the average post-operative hospital stay was 12 days. Complications were minimal: One minor air leak and two cases requiring prolonged drainage. Four patients with chronic empyema required conversion to open thoracotomy. Overall morbidity was low, and cosmetic outcomes were favorable. Conclusion: Two-port VATS is a safe and effective modality for managing pediatric empyema thoracis. Compared to traditional thoracotomy, it offers reduced morbidity, shorter recovery, and superior cosmetic results. It should be considered a preferred surgical option in children with advanced empyema not responding to medical therapy.